PATENT APPLICATION FEE DETERMINATION RECORD
Effective October 1 , 2003
CLAIMS AS FILED -PART I
Application orDocket Number
TOTAL CLAIMS
FOR
NUMBER FILED
NUMBER EXTRA
TOTAL CHARGEABLE CLAIMS
minus 20=
INDEPENDENT CLAIMS
\^ minus 3 =
*
\
MULTIPLE DEPENDENT CLAIM PRESENT
□
* If the difference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED - PART II
1!
lENTA 1
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
II s
Q
l|z
Total
*
Minus
**
1 |UJ
1 <
Independent
*
Minus
**+
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
(Column 1 )
(Column 2)
(Column 3)
IENTB
CLAIMS (
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
I s
Total
Minus
**
LU
Independent
*
Minus
***
j<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
p
'ENTC |
V
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
|2
|o
|z
Total
*
Minus
**
lui
S
Independent
*
Minus
***
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
SMALL ENTITY
TYPE
OTHER THAN
OR SMALL ENTITY
* If the entry in column 1 is less than the entry in column 2, write "0" in column 3.
** If the "Highest Number Previously Paid For IN THIS SPACE is less than 20. «nter ■»
***** "Highest Number Previously Paid For IN THIS SPACE is less than 3. enter -3."
The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1
RATE
' FEE
RATE
FEE
BASIC FE
E 385.00
OF
j BASIC FEI
S 770.00
XS9=
OF
I XS18=
X43=
OR
X86=
+ 145=
OR
+290=
TOTAL
OR
TOTAL
SMALL ENTITY
OR
OTHER THAN
SMALL ENTITY
RATE
Anni-
TIONAL
FEE
RATE
Ann!
TIONAL
FEE
X$9=
OR
X$18=
X43=
OR
X86=
+145=
OR
+290=
TOTAL
ADDIT. FEE
OR
TOTAL
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
X$ 9=
OR
X$18=
X43=
OR
X86=
+145=
OR
+290=
TOTAL
ADDIT FEE
OR,
TOTAL
RATE "
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$9=
(
DR
X$18=
X43=
(
DR
X86=
+145=
(
)R
+290=
TOTAL
ADDIT. FEE
C
■vo TOTAL
ADDIT. FEEL
FORM PTO-B75 (Rev. 10/03)
Patent and Trademark Office. y.S. DEPARTMENT OF COMMERCE